Wednesday, May 15, 2013

Universal EHR? No. Universal Data Access? Yes.

A recent blog posting calls for a "universal EMR" for the entire healthcare system. The author provides an example and correctly laments how lack of access to the complete data about a patient impedes optimal clinical care. I would add that quality improvement, clinical research, and public health are impeded by this situation as well.

However, I do not agree that a "universal EMR" is the best way to solve this problem. Instead, I would advocate that we need universal access to underlying clinical data, from which many different types of electronic health records (EHRs), personal health records (PHRs), and other applications can emerge.

What we really need for optimal use of health information is not an application but a platform. This notion has been advanced by many, perhaps most eloquently by Drs. Kenneth Mandl and Isaac Kohane of Boston Children's Hospital [1,2]. Their work is being manifested in the SMART platform that is being funded by an ONC SHARP Award.

Mandl and Kohane point to the iPhone as an example of building a platform on top of a common data store. I see this in action every day on my iPhone, when different applications make use of various data stores built into the phone, such as its GPS data. (Android and other phones offer similar functionality.) Not only Google Maps uses this data, but also my LA Fitness app that tells me where the nearest club is located when I am in a different city and hoping to find a gym.

A common data store, on top of which a thousand flowers (or apps) can bloom, is the ideal situation to the health information system "ecosystem." This will allow new ideas and innovations to flourish, while insuring that interoperable data will be accessible by all apps that have appropriate and authorized access. It will insure competition and a healthy marketplace to bring out the best in health information technology.


1. Mandl, KD and Kohane, IS (2009). No small change for the health information economy. New England Journal of Medicine. 360: 1278-1281.
2. Mandl, KD and Kohane, IS (2012). Escaping the EHR trap--the future of health IT. New England Journal of Medicine. 366: 2240-2242.

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